MEDICARE: RONALD D PEAK D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00127400	NJ

General Provider Information

NPI Number	:	1487842555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD D PEAK D.C.

Provider Business Mailing Address
First Line	:	4516 CHURCH RD
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2210
Country	:	US
Telephone Number	:	856-778-8653
Fax Number	:	856-596-2832

Provider Business Practice Location Address
First Line	:	4516 CHURCH RD
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2210
Country	:	US
Telephone Number	:	856-778-8653
Fax Number	:	856-596-2832

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2007
Last Update Date	:	09/19/2011

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